1. Field of the Invention
Embodiments of the present invention generally relate to joint rehabilitation. More specifically, embodiments generally relate to methods of using a combination therapy including a viscosupplementation and physical therapy for joint rehabilitation in a patient.
2. Description of the Related Art
Knee osteoarthritis (OA) is among the most common causes of musculoskeletal pain and disability in the United States. Since there is no cure for OA at present, the primary aims of treatment are to reduce pain, maintain or improve function and mobility, and prevent or slow the progression of adverse changes to the joint tissues, while keeping potential therapeutic toxicities to a minimum. Current treatment guidelines begin with non-pharmacologic protocols, such as patient education, weight loss, and physical therapy.
Non-pharmacologic approaches frequently provide insufficient pain relief and restoration of function and mobility, and pharmacologic modalities become necessary. Although simple analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) provide relief for many OA patients with mild to moderate pain, alternatives should be considered for patients who fail to obtain adequate symptomatic relief with these measures. Although NSAIDs and/or cyclooxygenase 2 (COX-2) selective inhibitors are frequently effective for the relief of moderate to severe OA pain, these options are not always effective, and may be inappropriate in patients with gastrointestinal or cardiovascular risk factors. Furthermore, analgesics are designed to prevent the sensation of pain and thus will not prevent or delay further degradation of the joint.
For patients who do not get adequate pain relief from simple analgesics, like acetaminophen or from exercise and physical therapy, intra-articular injections of hyaluronate provide another treatment option to address symptomatic pain and delay the need for a total joint replacement surgery. It is known that the concentration of native hyaluronate is deficient in individuals suffering from OA and, therefore, joint injections of exogenous hyaluronate is believed to replenish these molecules and restore the viscoelastic properties of synovial fluid. It is this property that is responsible for lubricating and cushioning the joints. Independent of the mechanism of action, pain relief can be observed for about six months following a treatment course of hyaluronate. A treatment course for hyaluronate products on the US market can range from single injection product to others that require 3 to 5 once a week injections to attain this durability of pain relief.
However, as stated previously, pain relief does not solve the problem. Analgesics mitigate the pain but provide minimal benefit to stemming the progression of OA in the knee. Hyaluronate or physical therapy as currently provided also reduce pain to some extent, but overall degradation of the joint is not significantly affected. As such, there is a need in the art for better methods of treatment for OA.